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7/28/2019 Css Burn Amri Stase Bedah

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CSS BURN INJURY

M Amri Kautsar

12100112028

preceptor : H. Catur Setyo dr., Sp.B M.Kes FINACS


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Stop Further Injury

A. Remove victim from source.B. Extinguish or remove buring clothing.

C. Chemical Burns1. Continuous water rinse or lavage2. Prolonged eye irrigation scene

3. Remove contaminated clothing4. Avoid injury wear clothes and PPE


3/22

Maintain ventilation

A. Administer humidified 100% oxygen by mask totreat possible carbon monoxide poisoning.

B. Examine airway for signs inhalation injury;


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C. Maintain AirwayD. Consider Airway thermal injury if thesesigns and symptoms are displayed:

Difficulty breathing Sooty, expectorated sputum Strider

Cough Nasal hair or oral mucosa burns Hoarseness Decreased PaO2: FiO2


5/22

Maintenance of peripheral circulation in patients withcircumferential burns.

A. Remove rings and braclets-give to family.

B. Clinical Signs of impaired circulation:

1. Cyanosis2. Impaired/delayed capillary filling

3. Progressive neurologic signs: paresthesias and

paresis, i.e numbness and weakness.

4. Doppler extremity pulses.


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Physical Examination

A. Check for associated injuries.

B. Estimate extent and depth of burn

-Rule of Nines- Childs head isdisportionately larger than adult head.

C. Estimate weight of the patient.


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Initial Burn Wound Care

A. Clean and debride loose tissue.B. For small burns


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History

A. Circumstances of injury

B. Pre-existing illnessC. MedicationsD. Allergies

E. History of enclosed space fire?

F. History of alcohol or drug use?


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Head and neck 9% Front torso 18% Back torso 18% Upper extremities 9% Each Lower extremities 18% Each Genitalia 1%

Total 100%


10/22

Rule of Nines


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Head and Neck 18% Front torso 18% Back torso 18% Upper Extremities 9% Lower Extremities13.5% each Genitalia 1%

Total 100%


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Severity of Burn Injury

1. Superficial or First Degree

Epidermis No Blisters 2. Partial Thickness or Second Degree Deeper dermal layers Blisters 3. Full Thickness or Third Degree Full skin thickness

Charring

4. Full Thickness Full thickness involving bones and muscles


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Superficial Partial Thickness


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Deep Partial Thickness


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D F ll Thi k


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Deep Full Thickness

D t i i C iti lit f B


20/22

Determining Criticality of Burns

Minor - Superficial burns and small partialthickness burns 15%-30% BSA

small full thickness burns

Severe Partial thickness of >30% BSA + FullThickness >15% BSA

Burns to hands, feet, face, genital or withcircumferential patterns are critical

Inhalation injuries are always critical

C b i S t


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Carbonacious Sputum


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Intravenous Fluid TherapyA. Required by patients with burns greater then 20% of

total body surface.B. Secure large bore IV in good vein.

C.

Estimate fluid needs for 1st 24 hours postburn

D. Administer 1/2 of calculated volume in 1st 8hrs.

Calculations: Adults 2-4ml LR x weight in kilogram x

percent burn = 24 hour requirement. Children less then4 ml/kg/% plus maintenance fluids.

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